Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation

Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1595-1599. doi: 10.1007/s00167-018-4903-9. Epub 2018 Mar 21.


Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

Keywords: Fourth-degree burn; Iatrogenic burn; Intramedullary screw; Jones fracture; Metatarsal fracture; Osteomyelitis; Segmental bone defect; Stress fracture; Thermal necrosis.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Basketball / injuries
  • Bone Screws
  • Bone Transplantation*
  • Burns / etiology
  • Burns / surgery*
  • Foot Injuries / etiology
  • Foot Injuries / surgery*
  • Fracture Fixation, Intramedullary / adverse effects*
  • Fracture Fixation, Intramedullary / instrumentation
  • Fractures, Bone / surgery*
  • Humans
  • Male
  • Metatarsal Bones / injuries*
  • Metatarsal Bones / surgery
  • Osteomyelitis / etiology
  • Postoperative Complications / surgery
  • Return to Sport
  • Surgical Flaps
  • Tendons / surgery
  • Transplantation, Autologous